The Ideas Bazaar

Skilled Practitioners and Concrete Cabbages

It is always nice to see something come to fruition. This is especially true of a Ph.D thesis, the production of which I often liken, in terms of its experience quotient, to the excretion of a concrete cabbage. 

So I was happy to be contacted by Kyle Kilbourn, the first intern at Digital Health's labs in Europe in 2006, shortly after we set up the social science and design teams. He made a stirling contribution to a wonderful project we did exploring the material culture of ageing in Ireland. It was our first opportunity to conduct fieldwork in the country, so acted as a first 'blooding' and we learned lots about ageing, health and independent living which for many of us was a new area of investigation. 

Kyle has just completed his PhD defence, successfully, although he is now working at IDEO in Boston. His thesis:"The patient as skilled practitioner – A design anthropology approach to enskilment in health and technology" draws on some of that work in Ireland, and seems influenced by the time he spent with Tim Ingold and others at Aberdeen, 

Kyle may, on the recommendation of the examiners, publish the thesis so he's not widely circulating it at this time but very smartly he's making it available, all nicely printed and bound via Lulu. What a great idea. Here's the link - a bargain at about $8. 

And the abstract:

 

The location of healthcare has oscillated between home and hospital over the centuries.  In each movement aspects of a particular practice carry over into the next.  This dissertation looks at the current shift towards care at the hands of “patients” and challenges the hidden work such a concept enforces.  The patient as skilled practitioner refers to the ways these people become skilled in self-care through the use of medical devices in their everyday life.  Introducing empirical material from medical areas as diverse as hemodialysis, diabetes and aging, this thesis argues for a design anthropology approach to enskilment.  Design experiments span along with anthropological theory of skilled practice, aesthetics of everyday life and perception, woven into multi-sited research project.

 

Theoretical contributions include a design-orientated knowledge of enskilment in which environment structuring, meaning-making and situated bodily learning form the foundation.  In designing for enskilment, the potential strategies of spectrum for cooperating, gaps for growing, and platforms for performativity are introduced.  The dissertation provides a contextually nuanced understanding of interaction in healthcare and crafts future research potentials in which technology may respect the skilled practice of self-care practitioners.

Chromosocks

Via the BMJ (Vol 337 11th October) a short piece about Gina Glover, an artist who has just finished a year long residency at Guy's and St Thomas' NHS Trust

For more see Art In Hospitals which is a catalogue of her work across a huge range of health settings in the UK, for example documenting life in a renal centre.

Striped Socks arranged as human karyotype (?), from 2003.

Doctors' ties arranged to demonstrate sperm morphology

The BMJ reports that:

"last week Glover, who has worked in more than 15 hospitals across the country, was awarded a medal from the Royal Photographic Society for advances in photography in public spaces. She has said that one of the challenges of working in hospitals is ensuring that she captures the complex and emotive areas of medicine with accuracy and sensitivity."

Big Job, Good Job

Thinking Allowed (10th Sept 2008) alerted me to this fascinating looking book on, well, poo. It appears to adopt the now familiar 'social life' approach examining a substance and set of practices which, for reasons that are as obvious as they are inexplicable, have largely avoided academic or even pseudo-scholarly, popular approaches. 

As author Rose George's website puts it,this is a pressing topic indeed:

2.6 billion people lack the most basic thing that human dignity requires. Four in ten people in the world have no toilet. They must do their business instead on roadsides, in the bushes, wherever they can. Yet human feces in water supplies contribute to one in ten of the world’s communicable diseases. A child dies from diarrhoea - usually brought on by fecal-contaminated food or water - every 15 seconds.

Meanwhile, the western world luxuriates in flush toilets; in toilets that play music or can check blood pressure, where the flush is a thoughtless thing, and anything that can go down a sewer...

there are mutliple aspects to this hidden world which, at least in the developed West, we partake of in near Fort Knox like security and privacy. There's the economics of the waste - flushing poo down a loo with potable water, then cleaning the water again so that is potable; there are cultural and gender issues to accessing places to go to the toilet; there's the technological issues of re-using waste and extracting gas from it - and the cultural issues of embedding this technology into pre-existing ecosystems of waste removal and farming. There's geographical issues too - as the world urbanises so creating the space, and the infrastuctures for poo-ing becomes an ever bigger challenge. It pout in mind of anthropologist Francesca Bray's work on toilets - American Modern

Healthy Mass Observation

The Mass Observation project/movement lives on (new website too). I'm particularly intrerested in the latest directive - call to observers to write in on a specific issue (want to become one?) - which is focused on health and social care experiences - You & the NHS in 2008.

Specifcally the directive looks for comments on the following areas:

How have you been treated by the NHS in the last decade?
What improvements and/or deterioration have you experienced? (for example: GP services, out of hours services, hospital services, waits for referral and appointments, physiotherapy and in particular dentistry.) What was your relationship with staff like? Did you feel safe and treated with dignity?

Do you have any experience of private health care or care abroad which you can compare with care received in the NHS?

Please describe any specific health and social care experience from the list below that apply to you and your family: as patients, carers or health professionals

• Childbirth, child or adolescent health
• Long term conditions  - for example asthma, diabetes, heart disease, cancer, multiple sclerosis, mental illness, physical and/or learning disabilities
• Older age including dementia, dying and death
• Self help and support from self help groups
  

Your views on the future of health and social care and the NHS

The costs
How do you think health and social care should be paid for?

Health care priorities
As resources are limited, what would be your priorities? You might want to consider expensive new drugs; further reductions in waiting times; more care at home rather than hospital; more private services delivered in the NHS; or something else?

And so it goes on.

Why post this?

I'm fascinated by this 'long conversation' approach to policy and wonder to what extent the findings from observers could be fed back into the current debates and Green Paper preparations that are in play - who will read these missives? Or, to what degree will this effort produce an noteworthy historical resource to be used to analyse the gaps between the reports and the ensuing policy. Either way, it shows that Mass Obs has the ability to live on, and evolve to address current issues and concerns, and demonstrates that the idea of people-centred / user consultation is not quite as new as some would have us believe.

Scale and Diligence

A brief excerpt from the wonderful book by Atul Gawande Better: A Surgeon's Notes on Perfomance, which details a WHO led effort to try to prevent the spread of polio in southern India when a case was detected there in 2003. The plan referred to was designed to cover an area of 50,000 square miles:

The plan, he said, was to employ  thirty-seven thousand vaccinators and four thousand healthcare supervisors, rent two thousand vehicles, supply more than eighteen thousand insulated vaccine carriers, and have the works go door to door to vaccinate 4.2 million children. In three days.

This is in a section of the booked entitled Diligence. Why? For the reason that the challenge facing the team of 37,000 was that they had to reach at least 90% of the target population, children under 5 years of age, or risk the failure of the entire 'mop up' operation.

Let Me Die A Young Man's Death

One of the participants at the Chronic Care at the Summit, Prof Roy Jones, qouted the second verse of this poem.

Let Me Die A Young Man's Death (Roger McGough)

Let me die a young man's death,
not a clean and in between
the sheets holywater death,
not a famous-last-words
peaceful out of breath death.

When I'm 73
and in constant good tumour
may I be mown down at dawn
by a bright red sports car
on my way home
from an allnight party.

Or when I'm 91
with silver hair
and sitting in a barber's chair,
may rival gangsters
with hamfisted tommyguns burst in
and give me a short back and insides.

Or when I'm 104
and banned from the Cavern
may my mistress
catching me in bed with her daughter
and fearing for her son
cut me up into little pieces
and throw away every piece but one.

Let me die a youngman's death,
not a free from sin tiptoe in
candle wax and waning death,
not a curtains drawn by angels borne
'what a nice way to go' death.

Take Heart

I've just given a keynote on Intel's healthcare R&D at The Wellcome Trust on Euston Road, London. It seemed to go well enough. We got to visit some of the exhibition areas afterwards in the newly refurbished venue (which is well worth visiting or dropping in to. Great bookshop and cafe. Free wifi.) One exhbition is called The Heart, and runs til mid September. Well worth a visit, for an ecclectic collection of heart related sounds, organs, pictures, photography and 'things'.

I was captivated by this infogram and the equation for lifespan which it presents.

It turns out that this equation produces a lifespan for humans of 31 years. Whilst the equation works out more accurately for the other animal in the example, this is, thankfully, not the case for humans. Turns out that medical and other social and technological developments have allowed humans to extend their lifespan by some 40-60 years. A reminder of what humans can achieve in shaping their own historical or biographical destinies in the face of biological reality and of course, a reminder that econonomic, medical and other circumstances ties people in many parts of the world closer to the outcome of this simple equation of life.